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The Consequences of the “Missing Girls” of China
Avraham Y. Ebenstein and Ethan Jennings Sharygin
In the wake of the one-child policy of 1979, China experienced an unprecedented rise
in the sex ratio at birth (ratio of male to female births). In cohorts born between 1980
and 2000, there were 22 million more men than women. Some 10.4 percent of these
additional men will fail to marry, based on simulations presented here that assess how
different scenarios for the sex ratio at birth affect the probability of failure to marry
in 21st century China. Three consequences of the high sex ratio and large numbers of
unmarried men are discussed: the prevalence of prostitution and sexually transmitted
infections, the economic and physical well-being of men who fail to marry, and
China’s ability to care for its elderly, with a particular focus on elderly males who fail
to marry. Several policy options are suggested that could mitigate the negative consequences of the demographic squeeze. JEL codes: I18, J11, J12, J13, J26, N35
In an attempt to halt explosive population growth in China, the framers of the
one-child policy of 1979 projected that if every woman of childbearing age had
an average of 1.5 children, China would reach a peak population of approximately 1.2 billion in 2030, slowly declining thereafter to an ideal level of 700
million by the late 21st century (Yu 1980, projection 4). While these projections were remarkably accurate considering the available information, officials
did not fully anticipate the impact of the fertility controls on the sex ratio at
birth (the ratio of male to female births) and the social consequences of high
sex ratios.1
Avraham Ebenstein is a Robert Wood Johnson Scholar in Health Policy at Harvard University; his
email address is [email protected]. Ethan Sharygin né Jennings (corresponding author) is a
Ph.D. student at the Population Studies Center at the University of Pennsylvania; his email address is
[email protected]. The authors thank Steven Leung for excellent research assistance, Sharona
Shuster and Claudia Sitgraves for their careful editing, and Monica Das Gupta and Bill Lavely for their
helpful comments and suggestions. An additional debt of gratitude is owed for the careful attention of
four reviewers—the journal editor and three anonymous referees.
1. Song Jian, a leading scientist and politician credited with innovations in science and mathematics,
was charged with developing policies to put China’s population trajectory on the optimal path
(Scharping 2003). This second-best scenario (after the ideal of one child per couple) was projected to
result in a total population of 1.17 billion in 2025, declining to 777 million by 2080. While Song’s
projections did not incorporate the dramatic change in the sex ratio of births following introduction of
the one-child policy, they did account for the already higher sex ratio of births in China.
THE WORLD BANK ECONOMIC REVIEW, VOL. 23, NO. 3, pp. 399 –425
doi:10.1093/wber/lhp012
Advance Access Publication November 5, 2009
# The Author 2009. Published by Oxford University Press on behalf of the International Bank
for Reconstruction and Development / THE WORLD BANK. All rights reserved. For permissions,
please e-mail: [email protected]
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Government controls on marriage and childbirth instituted in the 1970s
were intended to reduce population growth through delayed marriages, longer
gaps between births, and lower lifetime fertility, a set of policies known as wan
xi shao (later, longer and fewer). In 1979, a countrywide one child per couple
policy was introduced. As the policy was codified and policy enforcement diffused throughout the country over the 1980s, parents unhappy with the prospect of never having a son became an increasingly common phenomenon. For
many parents, intense son preference and the introduction of sex-selective abortion—made possible by the legalization of abortion after 1979 and the introduction of ultrasound technology in the early 1980s—led to a “merger of
Eastern philosophy and Western technology.” As a consequence, cohorts born
between 1980 and 2000 included 22 million more men than women, a
phenomenon known as the “missing girls” of China. According to projections
in this article, approximately 10.4 percent of the men in these cohorts can be
expected to fail to marry.
The popular press is replete with predictions that the vast number of unmarried men will destabilize Chinese society and represent a “geopolitical time
bomb.”2 Hudson and den Boer (2004) argue that the high sex ratios in China
will be associated with an increase in crime, since most violent crime is committed by unmarried young men. They also suggest that the poor marital prospects for these men may lead to China taking a more aggressive stance in world
affairs, as happened before. In the 18th century, the Qing dynasty government
responded to the rising sex ratios brought about by high levels of female infanticide by encouraging single men to colonize Taiwan. And in the 19th century,
poor economic conditions in Shandong province led to rampant female
infanticide and a subsequent rebellion when the unbalanced cohorts matured
and organized an uprising against the Qing dynasty (Poston and Glover 2004).
The relevance of such examples to modern China is unclear, since empirical
evidence is lacking on the connection between large numbers of single men and
social upheaval. The potential consequences of this gender imbalance has
spurred research in several disciplines, including demography, political science,
and economics, but more work on the direct causal links between high sex
ratios and social disorder is warranted.3
High sex ratios at birth have several predictable consequences, which this
article analyzes. It finds that the growing population of unmarried men will affect
the prevalence of commercial sex activity and the transmission of sexually transmitted infections, including HIV. And men who fail to marry may be worse off
economically and will not have children to support them in their old age.
2. Michael Fragoso, “China’s surplus of sons: a geopolitical time bomb,” Christian Science
Monitor, October 19, 2007. Retrieved from www.csmonitor.com/2007/1019/p09s02-coop.html)
3. Edlund and others (2007), exploiting time variation in the introduction of China’s one-child
policy to estimate the impact of high sex ratios on crime rates, find that the rising sex ratio explains a
third of China’s recent increase in crime rates.
Ebenstein and Sharygin
401
Understanding the social and economic consequences of high sex ratios in
China is critical in light of the persistence of this phenomenon since the advent
of the one-child policy. The high sex ratios of cohorts born in the past two
decades have already altered the demographic destiny of China. The shortage of
women lowers the reproductive potential of the population and accelerates the
shrinking of the population in the 21st century, absent a return to replacement
fertility rates (Cai and Lavely 2005). Recent Chinese government figures indicate
that the female deficit has actually worsened since the 2000 Census, with the
official sex ratio at birth reaching 120 boys for every 100 girls in 2008 (China
National Population and Family Planning Commission 2009).4 Unless action is
taken to reverse this trend, the negative consequences appear all but inevitable.
This article is organized as follows. The first section presents background
information on marriage and fertility and uses population simulations to assess
how different scenarios for changes in the sex ratio at birth and the total fertility rate could affect the share of men who fail to marry in China over the next
century. Section II discusses the expected consequences of the high sex ratios
and the failure of men to marry for migration, commercial sex activity, and the
prevalence of sexually transmitted infections, with a focus on HIV. Section III
explores the implications of the sex imbalance on China’s ability to care for its
elderly in an aging population with a growing number of unmarried, childless
men. Section IV briefly discuss the benefits of marriage using indicators of
economic and physical well-being and examines the welfare impact of the
failure to marry on health and financial outcomes. Section V briefly discusses
current efforts by the Chinese government to address the consequences of the
skewed sex ratio and summarizes several policy recommendations for China in
light of the anticipated costs of this worrisome demographic pattern.
I. DEMOGRAPHIC CONSEQUENCES
OF
CHINA’S “MISSING GIRLS”
This section contains background information on marriage and fertility in
China and presents several scenarios on how changes in the sex ratio at birth
and the total fertility rate could affect the share of men who fail to marry in
China over the next century
Marriage, Fertility, and Sex Ratios in China
The failure of men in China to marry because of a shortage of women is not
an entirely new phenomenon. High sex ratios could be observed even in the
19th century, when missionaries reported that women they interviewed indicated very high rates of female infant mortality (Coale and Banister 1994).
China’s 1982 Census shows that nearly 6 percent of men born between 1935
and 1945 failed to marry, compared with less than 2 percent of the women
4. A discussion of alternative calculations of the sex ratio of new births is available in Goodkind (2008).
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T A B L E 1 . Marriage Rates for Men in China, by Decadal Birth Cohorts,
1935–45 to 1955–65 (percent)
1935– 45
Category
Men
Share never married
5.88
Sex ratio of cohorts (ratio of men to women) 1.14
Share illiterate, ever-married men
20.8
Share illiterate, never-married men
48.6
1945– 55
1955– 65
Women
Men
Women
Men
Women
0.18
n.a.
n.a.
n.a.
5.49
1.08
7.7
33.3
0.29
n.a.
n.a.
n.a.
3.82
1.04
1.1
12.7
0.38
n.a.
n.a.
n.a. is not available.
Note: The share never married and the sex ratio of the cohorts in each column is calculated
using data on individuals observed in these cohorts. The observed sex ratios are slightly higher
than at the time these individuals were of marrying age, since adult mortality rates are higher for
men than for women. Age at marriage is calculated using the 2000 Census, and so the sample is
restricted to men born in these cohorts and still living at the time of the census.
Source: Authors’ analysis based on data from China National Bureau of Statistics (1982,
2000) and China Population and Information Research Center (1990).
(table 1). Marriage prospects for men born between 1945 and 1955 were only
slightly better, with 5.5 percent failing to marry.5 Chinese men who remain
single are known as “bare branches” (guang gun), since they will fail to extend
the family tree. In each cohort since 1935–45, unmarried men have lower literacy rates than men who marry. The concern over these “bare branches” is
thus partly due to the distributional consequences of this phenomenon, since
men with the worst economic prospects are generally forced to bear the
additional burden of remaining single.
Relative to earlier (and later) cohorts, men born during China’s baby boom
of the 1950s and 1960s had better prospects. Higher fertility rates in these
decades were associated with less distorted sex ratios, since parents were able
to have a son without resorting to sex selection. This population growth
allowed men to select brides from a larger group of younger women. The age
gap between men and women at first marriage decreased as men were able to
marry at a relatively younger age (figure 1).
China is on the cusp of a dramatic deterioration in men’s marital prospects.
The sex imbalance between potential spouses of the same age group is forecast
5. One surprising finding is that the marriage rate was very high for cohorts of men born between 1935
and 1944 (almost 95 percent), despite the high sex ratio in these cohorts. The ratio of men to women was
roughly 1.14, so more men might have been expected to fail to find a spouse. One explanation for the high
marriage rate among these men is that the sex ratios of cohorts entering the marriage market in the 1960s
were falling. Many of the men from previous cohorts delayed marriage and married women from these
younger cohorts. Intuitively, the observed increase in the age gap in spouses of a full year implies that on
average men delayed marriage one year and thus had an additional cohort of women to choose from (given
that women do not generally marry men their age or younger men). Men’s ability to marry women in
younger cohorts has the potential to mitigate sex ratio distortions in any particular cohort. Such adaptation
was also observed in England following World War I and in other contexts where people feared a collapse
in the marriage market, but none occurred (Bhrolchain 2001).
Ebenstein and Sharygin
403
F I G U R E 1. Average Age at Marriage by Sex and Spousal Age Gaps, China
1940–2000
Source: Authors’ analysis based on data from China National Bureau of Statistics (2000).
F I G U R E 2. Sex Ratio of Marriage-Age Adults in China, 1950–2030
Note: The marriage market is defined as men ages 22 –32 and women ages 20 – 30. The sex
ratio for each year is calculated using data from the 2000 Census, modeling population changes
with age – sex – year specific mortality rates. The population is simulated forward from 2000 using
baseline fertility assumptions (explained in the text) and a sex ratio at birth of 1.09 from 2005
and beyond. The vertical dotted line indicates data from the 2000 Census.
Source: Authors’ analysis based on data from China National Bureau of Statistics (1982,
2000).
to be at its worst by 2020, as the cohorts with the highest sex ratios (those
born under the one-child policy) reach adulthood (figure 2). This projection
holds under the conservative assumption that the campaign to achieve a target
sex ratio of 1.09 has been successful in the most recent period for which no
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M A P 1. Sex Ratio of Children, Ages Birth to 15
Source: China National Bureau of Statistics (2000)
birth data are available.6 Fertility has been falling in China for decades, for a
number of reasons. Improvements in health have improved the survival rates of
children to adulthood, greater economic competition has increased the level of
investment necessary for each child, and government policy has encouraged
family planning to various degrees.7 This demographic transition, however, is
made more profound by the policy climate in China, especially legislation regulating minimum age at marriage and the one-child policy. As birth cohorts age,
they find that each successive generation is smaller than their own, giving rise
to a kite-shaped age distribution in many Asian countries.
There is a discrepancy between the geographic areas with the highest sex
ratios of children in China (map 1) and those with the largest shortage of
women of marriageable age (map 2). The sex ratios of children—reflecting
how strongly parents manifest a son preference—are highest in the Han
majority areas of Eastern China. By contrast, the sex ratios at marriageable
6. In contrast, the 2008 revision of the UN World Population Prospects projection for China assumes
that this level of sex ratio balance is not attained until 2050 (United Nations Population Division 2009).
7. Contraceptives, banned before 1953, became widely available after the government’s first birth
control campaign in 1957 (Hemminki and others 2005).
Ebenstein and Sharygin
405
M A P 2. Sex Ratio of the Marriage Market, Ages 20 –30
Note: The marriage market is defined as men ages 22– 32 and women ages 20 – 30.
Source: China National Bureau of Statistics (2000)
ages are highest in the non-Han regions to the west, south and north. These
are also the more remote and poor regions of China, where employment
opportunities have grown far more slowly than in Eastern China. If men
living in regions with better economic prospects are able to draw brides from
poorer areas, it would appear to provide additional evidence for the suggestion
made by many observers that Chinese society tends toward hypergamy
(marriage with a person of a higher social class or position; Parish and Farrer
2000).
Projecting the Number of Unmarried Men in China over the Next Century
Projecting the number of unmarried men in China depends on sex ratios in
future marriage markets, which in turn depend on the sex ratios at birth of
future cohorts and population growth rates. This section describes the derivation and results of population simulations that capture the anticipated effect
of high sex ratios on the number of unmarried men over the 21st century.
Decline in fertility could exacerbate the impact of the sex ratio imbalance,
since future cohorts of men would be unable to find brides in younger and
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smaller cohorts. But fertility rates in China are still a matter of scholarly debate.8
The simulations presented here assume a total fertility rate of 1.45, based on
China’s National Bureau of Statistics (2005b) estimate from 2004 survey data,
except where otherwise noted.9
The potential trajectories for the sex ratio at birth in China from 2006 to
2100 are summarized in four scenarios. The first scenario assumes an immediate correction in the sex ratio at birth to 1.06, which is overly optimistic but
represents a lower bound for the analysis. The second scenario assumes that
official policy such as the Care for Girls campaign is effective at stabilizing the
sex ratio at birth at 1.09, a level identified as a government target, although
there is no sign that this target will be achieved soon (Li 2007). The third scenario assumes that the sex ratio at birth in 2005 of 1.18 persists indefinitely,
and the fourth scenario assumes a further deterioration of the ratio to 1.25.
The simulation model allows for variations in fertility rates and the sex ratio
of new births. The estimates here assume modest increases in fertility to 1.75
births per woman by 2010, although the choice of this date is not theoretically
important. A return to replacement fertility without a concomitant adjustment
in the sex ratio of new births will have only a minor effect in the long run on
the percentage of the population failing to marry since it merely redistributes
additional women to marginally older men (see Supplementary Appendix S1,
at http://wber.oxfordjournals.org/, for additional fertility scenarios).
The simulations use age-specific mortality rates reported by Banister and
Hill (2004) and essentially assume no improvement in life expectancy from
2000 onward. The marriage rule assumes that men marry all available women
three years older or younger than they are until the supply of marriageable
women is exhausted. Though a simplification of real marriage markets, the
process nonetheless demonstrates the essential properties of a marriage market
in which marriageable women become increasingly scarce because of both
below-replacement fertility and an imbalanced sex ratio. The most realistic
scenario that mitigates the serious consequences of the unmarried men
8. Data from the 2000 Census indicate a total fertility rate of 1.22 children in the prior year (China
National Bureau of Statistics 2000). However, some argue that census officials were given misleading
information out of a fear of punishment by parents who had violated the one-child policy (Retherford
and others 2005). Such undercounting affects both fertility estimates and the observed sex ratio.
However, Cai and Lavely (2005) found that 71 percent of the missing girls in the 1990 census were still
missing in 2000. Also, the sex ratio of children ages birth to 4 in 2000 conforms well to the male to
female ratio of children ages 5 –9 in 2005 (1.19) from the China National Bureau of Statistics (2005a)
One Percent Inter-Census Population Survey of China. While not decisive, these findings suggest that the
undercounting issue is surmountable. Additional values for these parameters were included in the
analysis here because of the remaining uncertainty about the extent of the undercount phenomenon. Cai
(2008) summarizes the debate on China’s total fertility rate and estimates a value of 1.5– 1.6, in line
with other third-party estimates.
9. These projections forecast a continuation of current trends, including modest increases in fertility
at all ages. Many forecasts predict a rapid return to replacement fertility rates (Peng 2004). A
supplemental appendix to this article, available at http://wber.oxfordjournals.org/, explores the
sensitivity of the results to different fertility scenarios (table S1.2). The crucial assumption is not how
population changes, but how the relative supply of men and women will change as fertility changes,
which will be affected by the population size but will be less important than the sex ratio at birth.
Ebenstein and Sharygin
407
F I G U R E 3. Share of Men Ages 25 and Older Who Fail to Marry, under Four
Scenarios, 2000–2100
Note: The technical assumptions underlying marriage formation for the simulations are
outlined in detail in Supplementary Appendix S1 available at http://wber.oxfordjournals.org/. The
shares of unmarried men are evaluated for four possible trajectories for the sex ratio at birth,
ranging from an immediate correction to 1.06 to a further deterioration to 1.25.
Source: Authors’ analysis based on data from China National Bureau of Statistics (2000).
phenomenon is one that addresses both the sex ratio and fertility. To the extent
that marriage norms may change, the simulations overestimate the percentage
of men who fail to marry. However, assortative mating constraints are not
imposed, so the failure to marry rate is underestimated. In the end, these competing influences should largely cancel each other out. The details of the
matching algorithm and alternative specifications testing the sensitivity of these
results are described in Supplementary Appendix S1.
The results of the simulation are presented in figure 3. Under baseline assumptions, the share of men ages 25 and older who fail to marry will exceed 5
percent by 2020. As the cohorts born in recent years enter the marriage market
and some share inevitably fail to marry, the population of unmarried men will
rise well beyond this level. In the most optimistic scenario, where the sex ratio
returns to normal immediately in 2006, the share of men who fail to marry will
stabilize at just below 10 percent in 2060. In the second scenario, unmarried
men will represent roughly 10–12 percent of men ages 25 and older. In the
third and fourth scenarios, where the sex ratio at birth persists at either 1.18 or
1.25, the share of men who fail to marry will peak above 15 or 20 percent.
To some extent, these outcomes can be mitigated by realistic increases in both
the age at marriage and the age gap between spouses.10 This idea of demographic
translation was introduced to describe the shift of the age-specific fertility distribution observed in the postwar baby boom era, but it also applies to the case of sex
imbalance in marriage markets (Foster and Khan 2000; Ryder 1964). This view
10. Edlund (1999) demonstrates that son preference can account for increases in spousal age gaps
and also the pattern of hypergamy.
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holds that an excess of men over women in the marriage market can be fully compensated for by modest increases in men’s age at marriage. Using an estimate of 15
percent excess men over women, it appears that the share of men who fail to ever
marry can be kept close to the historical rate of 5 percent if the gap in age between
spouses reaches eight years by 2050 (see also Supplementary Appendix S1).
This back of the envelope calculation neglects to consider that, because fertility
rates are artificially held below natural replacement rates, each cohort of women
entering the marriage market is smaller than the last. Indeed, the simulation
results are highly sensitive to the assumption about the trajectory of fertility rates.
With a return to a replacement fertility rate in the next decade, the impending
problem of shortages of marriageable women can be averted, albeit by dramatic
increases in both the age at marriage and the age gap between spouses.
However, there are few indications that the total fertility rate will rise to the
natural replacement rate in the near future. The National Population and Family
Planning Commission recently reaffirmed its intention to maintain the policy
status quo for “at least another decade.”11 Moreover, the high sex ratios and
smaller size of birth cohorts under the one-child policy imply that the age gap at
marriage must increase until larger birth cohorts enter the marriage markets
(some 25 years into the future, at the earliest), at which point any social upheaval associated with shortages of women and delay in marriage will already have
occurred. In the more pessimistic scenarios, where the fertility rate remains
around 1.45 and the sex ratio at birth remains above the natural rate, the age
gap between spouses and age at marriage for men will necessarily rise ad infinitum as each cohort of men passes along the bride shortage to the next.
I I . “ B A R E B R A N C H E S , ” H I V, P R O S T I T U T I O N ,
AND
M I G R AT I O N
In light of the large number of men who will delay marriage and who are
anticipated to fail to marry, this section examines some of the potential negative impacts of high sex ratios.
In China during the early 1990s, growth in the number of people with HIV
was concentrated among intravenous drug users and recipients of tainted blood
transfusions. During the mid-1990s, however, HIV and AIDS began to spread to
new regions and populations not previously considered at risk. As the population
of single men rises, the transmission of HIV through risky heterosexual contact,
particularly commercial sex activity, will become an increasingly severe problem.
Currently, the number of people who are HIV positive who contracted the
disease through sexual contact is as large as the number who were infected
through intravenous drug use. Individuals who contracted the virus from sexual
activity represented half of all new infections in 2005 (China CDC and others
2006). The population that is HIV positive can be broken down into four
groups. Intravenous drug users (90 percent of them concentrated in far western
11. Jim Yardley, “China sticking with one-child policy,” New York Times, March 11, 2008.
Retrieved from www.nytimes.com/2008/03/11/world/asia/11china.html?_r=1.
Ebenstein and Sharygin
409
and southern provinces) account for 44.3 percent of infected people, and those
infected through sex account for 43.6 percent (China CDC and others 2006).12
The third group, those who donated or received blood from commercial blood
donors, account for 10.7 percent, and the remaining 1.4 percent of infected
people are those who were infected through mother-to-child transmission.
Considering the impending demographic pressures as heavily male birth
cohorts enter adulthood and encounter shortages of marriageable women, female
sex workers are an important at-risk group that has been understudied as an HIV
vector. In the 1980s, sex workers represented a small share of the population, but
between 1990 and 2000, prostitution expanded rapidly. Current estimates range
from 1 million women whose primary income comes from commercial sex to up
to as many as 10 million women engaging in paid sex of some kind.13
Recent evidence indicates that Chinese men are more likely than U.S. men to
have paid for sex and that young Chinese men are more likely than older men
to have visited a prostitute: 12.6 percent of men ages 21 –30 and 8.8 percent of
men ages 31 –40 have been to a prostitute.14 Moreover, Chinese men are less
likely than their U.S. counterparts to report that they use condoms regularly,
which places them at higher risk of sexually transmitted infection. While HIV
rates among prostitutes are difficult to measure, the HIV prevalence rate
among sex workers in Guangdong, Guangxi, and Yunnan provinces was as
high as 11 percent in 2000,15 and it seems reasonable to assume that the risky
sexual practices of illegal sex workers place them at higher risk of exposure.16
While not all single men will patronize sex workers, and married men will
also pay for sex, documenting the relationship between demographic change
and commercial sex activity is important, as the population of single men will
grow in the years to come.17 Identifying specific groups of men who are more
prone to patronize sex workers is also important because of the need to target
public health interventions to the groups most at risk.
To analyze the relationship between numbers of men in at-risk groups and
commercial sex activity, data from the Chinese Health and Family Life Survey
were used to calculate the percentage of men reporting having paid for sex, for
12. The provinces with the highest levels of intravenous drug use (90 percent of it heroin) are Yunnan,
Xinjiang, Guangxi, Guangdong, Guizhou, Sichuan, and Hunan. The share infected through sex includes
those who contracted HIV from sex with a sex worker (19.6 percent of the total number of people infected
with HIV), from an infected partner (16.7 percent), and from sex with men (7.3 percent).
13. Maureen Fan, “Oldest profession flourishes in China,” Washington Post Foreign Service, August 5,
2007. Retrieved from www.washingtonpost.com/wp-dyn/content/article/2007/08/04/AR2007080401309.
html.
14. Authors’ calculation from the Chinese Health and Family Life Survey data (Population Research
Center 2000). For comparable estimates, see Parish and Pan (2006).
15. This calculation is based on sex workers in detention centers, since prostitution is illegal in
China (Settle 2003).
16. See Merli and others (2006) for an epidemiological model of sexual transmission of HIV in China.
17. To date, research has not been conducted on the relationship between the size of the single-male
population and the supply of sex workers. While most researchers assume that the population of sex
workers will increase as demand for their services increases, it could also be the case that the marriage
squeeze for men may improve the marriage prospects of female sex workers and thereby take them off
the sex market. This is a promising area for future research.
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six regions (Population Research Center 2000). Paying for sex was most
common in the coastal southern region, encompassing the provinces of Fujian
and Guangdong, followed by the coastal eastern region including Jiangsu,
Shanghai, and Zhejiang Provinces and the far northeastern provinces bordering
the Democratic People’s Republic of Korea and the Russian Federation. The
majority of counties where a high percentage of men report having paid for sex
tend to be counties with high percentages of single men. (Data on commercial
sex activity are unavailable for Inner Mongolia, Tibet, and Xinjiang provinces.)
Among single men, young migrant construction workers make up a distinct
at-risk population who are particularly likely to pay for services from low-cost
female sex workers and are less likely to be educated about sexually transmitted
infections and condom use (Garfinkel and others 2005). A pronounced relationship is found between the density of construction activity and the prevalence of
commercial sex activity. In the urban provinces of Guangdong, Fujian, Jiangsu,
Shanghai, and Zhejiang, more than 7 percent of men report having ever paid for
sex. These and other areas of dense concentration of the construction industry,
such as northern Shandong Province and the counties surrounding Beijing,
merit particular attention from public health policy.18
The potential for an increase in HIV infection rates fueled by migrant
workers has attracted the attention of many researchers. Tucker and others
(2005) present compelling evidence that rising rates of sexually transmitted
infection in cities are due to the sexual practices of migrant workers, who are
demographically similar to the men who are projected to fail to marry: poor,
uneducated, and single. Chen and others (2007, p. 1658) analyze HIV rates
among a sample of patients being treated at 14 Guangxi clinics for sexually
transmitted infections and conclude that “China’s imbalanced sex ratios have
created a population of young, poor, unmarried men of low education who
appear to have increased risk of HIV infections.” A multivariate analysis of
factors that affect HIV status yields an odds ratio of 1.7 for single people relative to those who are married and 1.4 for men relative to women.
To determine how migration might affect the transmission of HIV, especially
migration to China’s growing urban centers, it is helpful to examine current and
expected migration patterns. Comparing the geographic distribution of sex ratios
at birth with the distribution of sex ratios among the current adult population
reveals the regions from which migration is likely to occur in the future (see maps
1 and 2). Particular attention should be paid to counties where the sex ratio is
abnormally high and where HIV prevalence is also high, such as the southwestern
provinces of Guangdong, Guangxi, and Yunnan (Lu and others 2006). As the
cohorts of men younger than 15 enter adulthood and experience demand–supply
imbalances in marriage markets, the likelihood of commercial sex encounters and
other risk-taking behavior increases. This dynamic is likely to be strongest in areas
where the risk of contracting HIV is highest. At the same time, as women migrate
18. The results for men in the construction industry are included in Supplementary Appendix S2.
Ebenstein and Sharygin
411
T A B L E 2 . Share of Men Ages 25 and Older Paying for Sex, and Simulated
HIV Prevalence in the Entire Population, by Sex Ratio at Birth, 2000–30,
2050, and 2070 (percent)
Sex ratio at birth
1.06
Category
2000
2010
2020
2030
2050
2070
1.09
2050
2070
1.18
2050 2070
Paid for sex
6.28 6.92 7.78 8.35 8.36 8.26 8.42 8.40 8.59 8.76
HIV prevalence 0.031 0.046 0.065 0.076 0.093 0.095 0.094 0.097 0.097 0.103
Note: The simulations profile behavior based on the age, sex, and marital status of the population. Rates of having paid for sex in these groups are imputed using calculations from the
1999/2000 Chinese Health and Family Life Survey (Population Research Center 2000). The HIV
simulations assume an odds ratio of 1.4 of men to women and a 1.7 odds ratio of single to
married individuals (Chen and others 2007). The total count of HIV positive population in
2000– 10 by this method is between the low and medium estimates of the Joint United Nations
Program on HIV/AIDS (UNAIDS, various years). Results before 2030 do not differ appreciably
by sex ratio at birth because of known characteristics of the population in 2000.
Source: Authors’ analysis using data from China National Bureau of Statistics (2000).
to wealthier coastal cities to maximize their marriage prospects, these young men
will also face pressure to migrate to cities, and both groups could bring HIV from
the countryside to cities. Results by Yang (2006) confirm fears that male migrants
experience elevated rates of HIV infection.19
The connections between cohort-specific sex ratios, prostitution rates, and
HIV transmission are complex, but it is clear that these factors are all responsible for the rising HIV rates in China. Given the correlation between percentages of unmarried men and commercial sex activity, how will the increase in
sex ratios and the ensuing failure of many men to find marriage partners affect
markets for sex? The results of a simple simulation show how the incidence of
prostitution might evolve (table 2). The simulation projects the share of men
who pay for sex, assuming that the gender, marital status, and age-specific
rates of having paid for sex found in 2000 persist during the 21st century. The
Chinese Health and Family Life Survey finds that 14.7 percent of single men
and 7.3 percent of married men admit to having paid for sex in 2000
19. A study by Parish and Pan (2006) found no significant difference in the risk of HIV contraction
between urban men and low-status male migrants. If confirmed, this could mean a reduced likelihood that
male migrants will carry HIV to cities, although female migrants may still play the same role. Many
migrants may eventually marry, which could decrease the spread of HIV (by reduced prevalence of
commercial sex or by containing the geographic spread of HIV if migrants return home to marry). Many
men will lack the means to migrate to urban regions or will leave the city after a time with new wealth and
marry at home. An anonymous reviewer noted that poor rural men have been less likely to migrate and that
those that do migrate are still more likely to partner with women in their home region. Going forward, it
can be expected that rural men who migrate to cities will be forced to compete with urban men for sex and
mates and therefore will be more likely to visit prostitutes, presenting a problem even if these men eventually
return home with wealth and marriage prospects. The conflicting results leave room for further study.
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(Population Research Center 2000).20 That information, plus the age profile of
commercial sex activity, can be used to calculate a hazard rate of the chance of
visiting a prostitute over the life cycle.
Although this calculation is admittedly imprecise, in that current rates of
having paid for sex represent a lower bound on the future prevalence of prostitution (due to increased levels of future migration from rural to urban areas),
the results show an increased demand for commercial sex among Chinese men.
Assuming continuation of current behavior patterns, increases in the sex ratio
at birth will create a modest increase in the share of men paying for sex.
Changes in policy, income, or sexual culture will likely be more important in
the future. Nevertheless, the simulations indicate that, almost immediately,
demographic change alone will contribute to 2 –3 percentage point increase in
the share of men paying for sex in the next 30 years.
The simulations of how demographic change will affect China’s HIV infection rate in the 21st century assume that the unknown hazard rate for HIV
infection by age and sex generates 650,000 cases (the current estimated
number of HIV cases in China) when applied to the population ages 22–40 in
2006. The share of the population that is HIV positive is then imputed to each
cohort by sex, age, and marital status using the odds ratios from Chen and
others (2007). Thus, these simulations attempt to model how HIV infection
rates will change driven solely by changes in the demographic structure of
China as cohorts with higher percentages of single men enter their sexually
active years. The results indicate that the infected population will increase precipitously over the next 30 years and stabilize at a higher rate of infection. As
with the results for patronage of commercial sex, the effect of variation in the
sex ratio at birth on HIV transmission is limited. Variation in the sex ratio at
birth between 1.06 and 1.25 (not shown) results in HIV infection rates in 2050
of 0.93–1.05 per 1,000. The greatest increase in HIV incidence, from 0.3 infections per 1,000 in 2000 to 0.76 per 1,000 in 2030, is a result of momentum
from the known characteristics of the population in 2000.
While these projections do not incorporate increases in the probability of
contracting the disease that might result as more people become infected, they
also do not assume any improvement in preventive behavior. Since the Chinese
government is beginning to respond to the impending HIV crisis, there is
reason to hope that these projections are overly pessimistic. The central government and local authorities show signs of recognizing the growing role of sex
workers in HIV transmission, and several pilot projects promoting safer sex
( practices such as condom use) are in place in Beijing, Fujian, Hubei, Jiangsu,
and Yunnan. Government budget allocation for HIV/AIDS efforts grew from
approximately $12.5 million in 2002 to about $100 million in 2005 and $185
20. These percentages are derived from a regression of an indicator for having paid for sex on
several demographic control variables, including marital status. See also the discussion of similar results
for these data in Parish and Pan (2006).
Ebenstein and Sharygin
413
million in 2006.21 The government is also treating more cases of HIV, with
projects such as the China Comprehensive AIDS Response (CARES) campaign,
a program initiated in 2003 to supply domestically manufactured antiretroviral
AIDS medication free to anyone who contracted the disease through tainted
blood transfusions. The effectiveness of such efforts will be critical in containing the virus as the sex ratio rises and the percentage of those who are married
falls among the sexually active population.
III. SUPPORT
OF THE
CH I L D L E S S EL D E R LY
This section examines the impact of China’s changing demographic structure,
with a growing population of unmarried and potentially childless men, on its
ability to care for its elderly. China’s age distribution in 2000 exhibits two pronounced spikes, both emerging as a legacy of its demographic transition
(figure 4). In the 1960s, the total fertility rate exceeded 6, and this baby boom
resulted in a large cohort of people ages 30 –40 in 2000.22 The second baby
boom occurred when these cohorts began to have children, and so the number
of children born in the 1990s was also large. However, in the wake of
government-mandated fertility control, each successive cohort in China has
been smaller than the previous one.
Although China’s population is more than four times that of the United
States, it has less than three times as many births.23 In 2030, the children born
in the second baby boom of the 1990s will still be in their most productive
working years and presumably will provide support (fiscal or otherwise) for
the elderly. However, by 2050, the population forecast for China is far worse
than that for the United States (see figure 4).24 The elderly dependency ratios
will be alarmingly high in China, with large numbers of people entering old
age without young workers to replace them. In contrast, even without further
immigration, the United States can anticipate a more favorable age distribution
by 2050, with a relatively young workforce and very few baby boomers left in
the population of elderly.
While retirement funding for social security programs in urban areas is
receiving research and analysis, the looming problems among the population of
rural peasants—who make up roughly 70 percent of China’s 1.3 billion
21. “Spending on HIV/AIDS prevention set to double,” China Daily, December 28, 2005. Retrieved
from www.chinadaily.com.cn/english/doc/2005-12/28/content_507212.htm.
22. Some researchers identify this bulge in the population as one explanation for China’s recent
rapid economic growth. This phenomenon, when a large cohort of workers, preceded and followed by
smaller cohorts reaches its most productive period in the labor force, is known as the “demographic
dividend.”
23. In China, only 10.6 million children were born in 1999 (and survived to 2000) compared with
3.8 million in the United States.
24. As projected in Alternative Scenario I of the 2007 Trustees Report by the U.S. Social Security
Administration (U.S. SSA 2007).
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F I G U R E 4. Age Structure in China and the United States in 2000 and 2050
Source: For China, authors’ simulations based on data from China National Bureau of
Statistics (2000); for the United States, authors’ analysis based on data from 2000 Census and
projections by the U.S. Social Security Administration (U.S. SSA 2007).
people—are potentially much larger, even though there are no explicit financial
promises to this population, such as social security or government-provided
medical care. As Lee (1994) discusses, the allocation of resources for old age
support can be mediated by financial markets, public sector programs, or intrahousehold transfers. In the absence of financial wealth or social insurance,
most of the elderly in rural China rely on intrahousehold transfers. A recent
Ebenstein and Sharygin
415
F I G U R E 5. Share of China’s Population Ages 65 and Older, 2000–2100
Source: Authors’ simulations as described in the text.
survey of heads of rural households found that 62 percent anticipate that their
children will be the primary source of elder care, while only 29 percent list personal savings as the anticipated source of support.25 Inadequate preparation
for old age among the rural peasant population may lead to severe financial
hardship and consequently to political instability. Already, China’s growing
income divide between urban and rural residents is arousing concern.
Differences in access to financial resources and social insurance may well contribute to this problem as the population ages and the need to provide for the
elderly becomes more pressing.
Combined with the findings in the following section on asset accumulation
by marital status, the failure to marry could have severe consequences for the
distribution of wealth among elderly men. Men who are able to marry and
have children will be distinctly advantaged over those who must delay their
marriages until old age or who remain unmarried. The financial markets and
public sector programs necessary to guarantee equity by replacing the intrahousehold transfer system are not in place. Thus an important area for future
development is the creation of public or private investment mechanisms for
men facing extended singlehood to provide for their health and financial wellbeing in advanced age.
The share of elderly in China will rise dramatically during the 21st century
(figure 5). By 2060, when the very large cohorts come of age, China’s over-65
25. Authors’ calculation from the 2002 Survey of Rural Households in China (China National
Bureau of Statistics 2002). A smaller share of people ages 20– 30 list children as their primary source of
old age support, but the share is still over half (51.3 percent).
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population will exceed 35 percent of the overall population.26 This aging of the
population occurs against the backdrop of an emerging generation of unmarried,
childless men.27 China’s traditional cultural assumption is that the elderly are
cared for by their children, and living patterns and fertility decisions are predicated on the presumption of familial support. The state has made some effort to
promote retirement homes (yang lao yuan), especially in rural areas, but these
efforts have met limited social acceptance or private investment interest.28
China’s population aging over the next 50 years has already been determined by the current age structure. It will coincide with the emergence of a
new group of permanently unmarried men that will impose a large and increasing cost on Chinese society, especially in 2050 and beyond. This problem,
common to all countries with a below-replacement fertility rate, is especially
acute where selective abortions have altered the sex ratio. A preference for sons
in China is at least partly economic, since sons have traditionally been the most
important source of old age support. Increased acceptance of daughters could
reduce welfare in old age if the additional girls are a couple’s only child and if
virilocality remains a social norm. In China, however, unlike in Italy or Japan,
for example, the possibility of fertility returning to the replacement level seems
much brighter because in China fertility may be significantly more responsive
to public policy changes.29 Actions taken today to allow Chinese to have larger
families could improve the support ratio and might also allow more couples to
have a son without resorting to sex selection, thus helping to reduce the
number of unmarried men in these cohorts.
I V. M A R I T A L S T A T U S
AND
WELFARE
This section examines the relationship between welfare and marital status, documenting the greater poverty, poorer health, and shorter life expectancy among
men who fail to marry, and possible developments in household bargaining
between spouses.
The Census and the China Household Income Survey indicate that failure to
marry is associated with lower income, less financial wealth, and poorer health
(table 3 and Supplementary Appendix S2, table S2.1). The selection of healthier, higher earning men into marriage is partly responsible,30 although there
26. The 2008 revision of World Population Prospects projects that 23.3 percent of the population
will be 64 or older in 2050 (United Nations Population Division 2009). The comparable figures for the
United States are 20.8 percent in 2050 and 21.6 percent in 2060 (U.S. SSA 2007, Scenario II).
27. Divorce or out of wedlock births are uncommon in China, so for most of these men, a failure to
marry because of a shortage of women will imply a failure to have children.
28. “China vows to promote home care for elderly” Xinhua News Agency, February 22, 2008.
29. Supplementary Appendix S1 presents results of the model for several scenarios that assume a
more rapid or slower pace of fertility growth, reaching replacement level at different dates.
30. Lillard and Panis (1996) present evidence that, in the United States, less healthy men marry
earlier and remarry more quickly following divorce, suggesting that negative selection into marriage by
health is also a potential confounding factor.
Ebenstein and Sharygin
417
T A B L E 3 . Marital Status and 10-Year Mortality Rates of Men, by Age
Groups
Age
group
Ever-married men
(percent)
Never-married men
(percent)
Difference (percentage
point)
55 – 59
60 – 64
65 – 69
70 – 74
75 – 9
14.3
25.7
41.3
59.6
77.1
15.2
39.1
51.3
67.5
86.1
– 0.9
213.4
210.0
27.9
29.0
Source: Authors’ analysis based on data from China Population and Information Research
Center (1990) and China National Bureau of Statistics (2000).
is some evidence in other countries that men’s wages rise after marriage,
suggesting a causal link (Korenman and Neumark 1991).
Even after controlling for a respondent’s age, education, ethnicity, and prefecture of residence, men in China who fail to marry have a third less income,
live in households with an eighth less wealth, and are 11 percentage points less
likely to describe themselves as being in good health than are men who marry.
While the causal link between marriage and welfare outcomes has not been
established in China in the period of interest,31 marriage could theoretically
improve health among married men through reductions in risky behavior and
economies of scale in household welfare (Drèze 1997; Lanjouw and Ravallion
1995; Lillard and Panis 1996). A link between marriage and welfare is
especially likely in China, because social insurance programs are limited and
familial support is correspondingly critical to welfare.
The poor financial and health status of unmarried men observed in the
survey particularly manifest in perhaps the most important measure of
welfare—life expectancy. Implied mortality rates of men who married and
those who did not between 1990 and 2000 were calculated by comparing the
number of men in the 1990 and 2000 census data by marital status and calculating the survival of the artificial cohort (table 3).32 Never-married and evermarried men who were ages 55–59 in 1990 had similar mortality patterns, but
at older ages the never-married men had higher mortality rates. For example,
among men ages 65–69, the mortality rate was 10 percentage points higher for
never-married men, and less than half of the never-married men survived to the
2000 Census.
The welfare cost of poor health and high mortality for this population of
unmarried men suggests that the high sex ratio at birth could indirectly reduce
31. For other countries, Hu and Goldman (1990) find significant mortality differentials by marital
status (China is not included in their analysis).
32. This calculation assumes that men do not marry for the first time past the age of 55. First
marriage beyond 50 is not observed among any of the respondents in the 0.1 percent sample of the
2000 Census (China National Bureau of Statistics 2000).
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the quality and shorten the duration of the lives of never-married men. While
the Chinese preference for sons results in high mortality rates for girls during
pregnancy and infancy, if the relation between marriage and health proves to
be causal, the outcome could be elevated mortality in later years for men
unable to marry because of the shortage of women resulting from the earlier
high mortality rate for unborn and infant girls.
It could also be the case that the shortage of female partners could lead to
increased competition for brides, which could result in behaviors, including
investment in education, that improve the health and well-being of men.33 As
the marriage market tightens, competition for scare women may increase the
bargaining power of married women as well as single women. Evidence from
outside China has shown that greater bargaining power of women, which can
result from gender mismatch in the marriage market, can positively affect
family health and welfare outcomes. These benefits, of course, would accrue to
men who find marriage partners but not to those who remain single throughout their adult years.34
The evidence presented here suggests that China’s demographic change in
the 21st century will be dramatic and that difficulties in supporting China’s
large elderly population will be compounded by high sex ratios, which will
deny childless men intergenerational support.
V. P O L I C Y R E P O N S E S
TO THE S HORTAG E OF FEMALES IN
CHINA
This section briefly summarizes the Chinese government’s policy response to
the problems associated with the high sex ratio and discusses its consequences
and possible alternatives.
When the one-child policy was introduced in 1979, China was only 20
years removed from the Great Leap Forward and the associated famine.
Today, China is rapidly industrializing and experiencing the growth of a
country that can easily feed its estimated 1.3 billion people. If current
trends continue, the population is set to begin declining within the next 20
years. While overpopulation is no longer a pressing concern in China, the
potential consequences of the legacy of missing girls is of immediate
importance.
The alarming increases in sex ratios at birth revealed in the 2000 census
spurred the Chinese government to action, and several programs were
33. An alternative strategy to reduce this uncertainty by identifying the causal direction for marriage
and health and wealth involves finding a factor that affects marriage probability but otherwise has no
influence on welfare. An instrument for marriage is difficult to find in China, since the factors affecting
marital success are so closely related to factors that affect welfare. Panel data would also be useful in
disentangling causality. The regression model presented in table S2.1 in Supplementary Appendix S2
includes controls that are important determinants of marital outcome and explain a good deal of
variation in marital probability in reconstructed cohorts from cross-sectional data.
34. For details, see Lundberg and Pollack (1996) and Rao and Greene (1996).
Ebenstein and Sharygin
419
implemented to address the female deficit. The government’s response can be
classified into two primary strategies: increasing the value of girls in the minds
of parents and reducing the availability of sex-selection technology. The Care
for Girls campaign identified 24 counties with extremely high sex ratios and
provided incentives to reduce the female deficit, including free public education
for girls. Preliminary indications are that these programs are having an effect.
In a joint venture of the Ford Foundation and the United Nations Children’s
Fund (UNICEF), the Chaohu Experimental Zone Improving Girl-Child
Survival Environment, established in 2000, succeeded in lowering the sex ratio
at birth from 125 in 1999 to 114 in 2002 (Li 2007). The government is currently expanding the Care for Girls campaign to a national initiative. In 2004,
President Hu Jintao declared that the campaign was a top priority and that the
government would work strongly to stop any further rise in the country’s sex
ratio at birth over the next three to five years (Li 2007). Zhang Weiqing, director of China’s population ministry, estimated that it would take 10–15 years
to return China’s sex ratio to natural level.35
In a second strategy, China is cracking down on sex-selective abortion.
Several legislative initiatives aim to curb the practice and to punish offenders.
The first statutory prohibition on sex-selective abortion came in 1989, and the
most recent family planning law of 2002 bans the use of ultrasound or other
technologies to determine fetal sex. If parents are caught aborting a child on
the basis of sex, health professionals performing the operation are penalized
and parents forfeit any right to have another child (Hemminki and others
2005). In 2006, the government shuttered several fertility clinics for violating
the policy.36 Despite these efforts, however, the sex ratio at birth was 1.18 in
2005, near the all-time high. Enforcement has been weak and uneven, possibly
due to the overriding obligation of local governments to meet stricter population growth targets. The perceived need for a national policy campaign hints
at an acknowledgment that sex-selective abortions have occurred, and the
timing of higher parity births is further evidence that the practice has continued
(Ebenstein forthcoming).
Efforts to improve funding for old-age security programs have been limited
in scope and have focused on urban areas (Wang 2006). Very limited efforts
have also been made to provide insurance in rural China, but they are insufficient for dealing with the looming old age crisis. In light of this concern, policy
efforts should be made in two directions. First, China must acknowledge the
implicit obligation to the large elderly rural population forecast for the next
generation, since this generation’s fertility has been too low to enable reliance
on the traditional intrahousehold mechanisms of elderly support. Expanding
35. Interview transcript “Xinwenban jiu jiaqiang jisheng gongzuo he renkou fazhan zhanlv deng
dawen,” Zhongguo zhengfu wang of January 23, 2007. Retrieved from www.gov.cn/zhibo49/wzsl.htm.
36. Joseph Kahn, “China: crackdown on abortion of girls,” New York Times, June 1, 2006.
Retrieved from www.nytimes.com/2006/06/01/world/asia/01briefs-brief-003.ready.html?_r=5.
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efforts to provide old age support and to collect the revenue to fund these
initiatives is a top priority. Second, the Chinese government might want to consider revising its fertility policy. The simulations presented here suggest that the
situation will deteriorate precipitously under the current policy, and higher fertility in the next decade would help smooth China’s age distribution. Allowing
extra births today will slow China’s demographic decline and establish a larger
supply of workers who could be taxed to fund the baby boom generation
when they reach retirement.
The Chinese government’s recent actions to provide contraception and care
for those infected with HIV are promising developments, but actions to
contain the spread of the disease must focus on the large and growing number
of unmarried men who are at risk. China’s legacy of missing girls will have a
dramatic effect on Chinese society in the 21st century, with increased internal
migration and rising demand for commercial sex all but unavoidable.
Government action is unlikely to effectively reduce the prevalence of commercial sex, and so policy should aim to reduce the danger of this activity by
raising awareness of the risk of contracting HIV and increasing the availability
of condoms, especially in regions that attract unmarried men. Although
China’s HIV rates are still low, failure to act soon could prove costly, and HIV
might be difficult to contain once it spreads to these unmarried men.
The future course of Chinese policy is yet to be determined. Central government planners, acknowledging the need to address the son preference, have
chosen to do so through education campaigns, punishment for sex-selective
abortions, and economic incentives for raising daughters. Although the onechild policy is subject to periodic review, its current fertility targets were
recently reaffirmed despite the desirability of higher fertility for several
reasons.37
The results presented here on some of the potential negative welfare consequences to having large numbers of men who fail to marry suggest at least two
strategies: increasing fertility, thereby reducing the demand for sex-selective
abortions and slowing population aging, and increasing legal and social incentives for raising daughters.38 The discussion on revising the one-child policy
has begun (Wang 2005). Many scholars have identified clear links between the
one-child policy and the high sex ratio at birth over the last 20 years, and so an
associated benefit of allowing higher fertility could be a mitigation of the costs
presented here. The simulations presented here also suggest that an impending
imbalance between working age and elderly cohorts in China could be offset
somewhat by higher fertility rates. The simulations also indicate the need to act
quickly. Even if action is taken immediately, China will still have to manage
37. Alexa Olesen, 2007, “China sticking to one-child policy,” Associated Press, January 23, 2007.
Retrieved from www.washingtonpost.com/wp-dyn/content/article/2007/01/23/AR2007012300398.html.
38. And reducing incentives for bearing sons, as might be expected to occur with increased
institutional support for elderly and retired workers.
Ebenstein and Sharygin
421
the highly skewed sex ratios in cohorts born over the last 20 years. Addressing
this problem for the second half of the 21st century requires action today.
VI. CONCLUSION
The most significant unexpected consequence of China’s one-child policy is the
decline in the number of female children born to parents who are subject to
strict fertility limits. In time, these missing girls will result in increasing tightness of the marriage market, with mixed consequences. This article attempts to
establish the magnitude of the expected imbalance as boys born during the
years of abnormally high sex ratios at birth and below-replacement fertility
rates enter the marriage market and find a dearth of female partners. Three of
the most important consequences of this phenomenon are the impact on prostitution, internal migration, and HIV transmission; the undermining of traditional old-age support mechanisms; and the impact on the health and
well-being of men in the event of an increase in the failure to marry or, in
demographic terms, in the lifetime celibacy rate.
As sons born during the years of skewed sex ratios reach adulthood and are
unable to find marriage partners, the dangers associated with increased commercial sex may translate into higher HIV incidence. Simulations, using what is
known about sexual preferences and practices, extrapolated increases in
patronage of sex workers and the incidence of HIV. The imbalance in sex
ratios of adults of marrying age will result in increased opportunities for
women who migrate from rural areas to marriage markets in wealthier areas
but will also put pressure on the men who are left behind to migrate to
cities or to engage in risk-taking behaviors, such as drug use and commercial
sex. The result could be the transmission of HIV from areas of high prevalence
in southwestern and central China to urban centers that have been insulated
so far. The share of men ages 25 and older who have paid for sex is
projected to rise from 6.5 percent to 8–9 percent, and the HIV incidence
rate is projected to rise from 0.3 per 1,000 to 0.8–1.1 per 1,000. Because of
demographic changes already in motion, variation due to future fluctuation in
the sex ratio at birth is likely to be minor compared with that due to government policies.
China has historically relied on family support systems for the elderly, with
parents residing with their adult sons. Although the one-child policy might generate economic benefits in the short term, as a relatively larger group of young
men are employed, in the longer run it means that a growing share of aging,
never-married men will have no family to support them in their old age. The
share of the population ages 65 and older is projected to peak between 2050
and 2060 at more than 35 percent. Without initiatives to fund the retirement
of childless men, a large share of today’s young men will face a tenuous existence as they age. There are additional concerns about the welfare of single men
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before they retire, as research has found positive mental and physical health
effects associated with marriage, regardless of marital fertility.39
Central government planners have tried to use incentives to encourage
families to have daughters without increasing fertility. These measures will ease
but cannot solve the problem of marriage market tightening for generations
born since 1982. Without a suitable policy response, improvements in the sex
ratio will not address the problems faced by retirees without family to provide
support in advanced age. Of all of the demographic consequences of China’s
missing girls, the possibility of an AIDS epidemic has attracted the most attention among policy planners.40 In the near term, major adjustments in marriage
market matching behavior are likely, and absent a comprehensive policy
response, a historically unprecedented population of men will likely suffer
health and income setbacks as a result of their failure to marry.
This article finds considerable room for government policy to improve the
likely effect of demographic trends on the spread of HIV. Also, vigorous efforts
to reduce son preference are showing initial success (Das Gupta, Chung, and Li
2009) Without timely reform of elderly support systems to capitalize on the
current surplus of working-age population, adjustments in total fertility and a
substantial shift toward equalization of the sex ratio of new births will be
crucial while these trends are still reversible, or the impending problems for
China’s guang gun will not be averted.
S U P P L E M E N TA RY M AT E R I A L
Two supplemental appendixes to this article are available at http://wber.
oxfordjournals.org/.
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